title: Failure to reassess ejection fraction after acute myocardial infarction in potential implantable cardioverter/defibrillator candidates: insights from the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health Status (TRIUMPH) registry.
abstract: BACKGROUND
  Current practice guidelines advocate delaying assessment of primary prevention implantable cardioverter/defibrillator (ICD) candidacy at least 40 days after an acute myocardial infarction (AMI) because early ICD implantation after AMI has not demonstrated survival benefit. The rate at which interval reassessment of left ventricular ejection fraction (LVEF) occurs in potential primary prevention ICD candidates is unknown.
  
  
  METHODS
  We examined patients with AMI in the TRIUMPH registry with inhospital LVEF <40% discharged alive after their index presentation, excluding patients with a prior ICD and those who declined ICD during the index admission or were discharged to hospice. We conducted multivariable Poisson modeling to identify independent factors associated with LVEF reassessment by 6 months after AMI.
  
  
  RESULTS
  Of the 533 patients meeting the inclusion criteria, only 187 (35.1%) reported LVEF reassessment in the first 6 months after AMI and only 13 patients (2.4%) underwent ICD implantation by 1 year. In multivariable analysis, early cardiology follow-up after AMI was associated with a higher likelihood of LVEF reassessment (odds ratio 1.16, 95% confidence interval 1.06-1.28), whereas uninsured status and cardiologist-driving inpatient medical decision making were associated with a lower likelihood of LVEF reassessment (odds ratios 0.84 [95% CI 0.74-0.96] and 0.78 [95% CI 0.68-0.91], respectively).
  
  
  CONCLUSIONS
  In contemporary practice, almost 2 of 3 potential primary prevention ICD candidates did not report follow-up LVEF evaluation, with a very low rate of ICD implantation at 1 year. These results suggest an important gap in quality, highlighting the need for better transitions of care.
authors.affiliation: Brigham and Women's Hospital, Boston, MA. Electronic address: almiller@partners.org.
authors.forename: Amy Leigh
authors.initials: AL
authors.lastname: Miller
authors.forename: Kensey
authors.initials: K
authors.lastname: Gosch
authors.forename: Stacie L
authors.initials: SL
authors.lastname: Daugherty
authors.forename: Saif
authors.initials: S
authors.lastname: Rathore
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
mesh_terms: D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D057170:Translational Research, Biomedical / Q000379:methods; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology